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Is the drug you’re taking the safest and most effective one for your medical condition, or is it a “me-too” drug — one that essentially duplicates the actions of an already existing drug, but at a higher price?

As a new investigative article from ProPublica reporters Charles Ornstein and Ryann Grochowski Jones points out, pharmaceutical companies spend millions of dollars wooing physicians to prescribe “me-too” drugs to their patients. They do this, in part, with free meals and educational gifts and by hiring physicians as consultants and promotional speakers. (And, yes, although most physicians will say that small gifts, such as free meals, have no influence on their prescribing preferences, research suggests otherwise. Pharmaceutical companies know this; that’s why they spend so much money on those gifts.)

In the last five months of 2013 alone, the manufacturers of just three new blood-thinning drugs (Pradaxa, Xarelto and Eliquis) spent almost $19.4 million on U.S. doctors to encourage them to prescribe one of those drugs rather than the much-older blood thinner Coumadin (warfarin), according to the ProPublica report.

Ornstein and Jones compiled that payment information from the Open Payments database, which has come into existence because of the Affordable Care Act. Their resulting investigation provides “the first comprehensive look at how much money drug and device companies have spent working with doctors,” the two reporters write. “What it shows is that the drugs most aggressively promoted to doctors typically aren’t cures or even big medical breakthroughs. Some are top sellers, but most are not. Instead, they are newer drugs that manufacturers hope will gain a foothold, sometimes after failing to meet Wall Street’s early expectations.”

“In almost all cases, older, cheaper products are available to treat the same conditions,” Ornstein and Jones add. “Companies typically try to differentiate the new drugs by claiming they are easier to use; carry fewer side effects; work faster than competitors; or have medical advantages.”

Top three

According to the ProPublica analysis, the drugs associated with the most payments ($9 million) to doctors during those five months in 2013 was Victoza, a diabetes medication made by Novo Nordisk.

“Victoza, through a once-a-day injection, helps lower blood sugar among diabetics, but researchers and advocacy groups have said drugs of its class carry an increased risk of thyroid cancer and pancreatitis,” write Ornstein and Jones. (A Novo Nordisk spokesperson told the reporters that the company had to spent that much money on doctors to address such safety concerns.)

Second and third on the list were Eliquis, the blood thinner (anticoagulant) co-marketed by Bristo-Myers Squibb and Pfizer ($8 million), and Brilinta, a blood thinner made by AstraZeneca.

Majority are new drugs

Among the 20 most-promoted drugs identified in this study, 14 were new drugs — approved by the Food and Drug Administration since 2010. Write Ornstein and Jones:

Some treat similar conditions, including diabetes, schizophrenia and chronic obstructive pulmonary disease, so the competition among them is fierce. “They’re fighting over the same doctors, I guarantee you,” said Rhonda Greenapple Simoff, founder of a consulting firm that advises pharmaceutical companies in Bernardsville, N.J.

Largely absent from the top of the list were drugs that cure disease, such as a new class of hepatitis C treatments, or those that significantly extend life, particularly for cancer patients. If a drug is either the first to treat a disease or is much better than existing drugs, said Dr. Sidney Wolfe, the founder and now senior adviser to Public Citizen’s Health Research Group, “they ‘sell themselves’ on the merits of their unique benefits.”

According to ProPublica’s analysis, a few of the most heavily promoted drugs, including Samsca, which treats low sodium levels in the blood, have serious side effects that came to light after their approval by the federal government. The manufacturers of several others, including Copaxone, Latuda, Xarelto, Daliresp and Humira, have been faulted by the F.D.A. for improper promotion.

For more information

You can read the full article on the ProPublica website. (It was co-published with the New York Times’ The Upshot.) The article includes a chart of the top 20 most-promoted drugs during the last five months of 2013.

In addition, you’ll find a useful app on the site that can help you see how much money is being spent on doctors (and teaching hospitals) to encourage them to promote a drug you are taking. ProPublica also has a “Dollars for Docs” tool that can help you determine if your physician has received payments from a drug or medical device company.

Comments (1)

The blood thining/anticoagulant example is not the best. The new agents have a different mechanism than Warfarin. They may be better for some patients where they lift dietary restrictions and the need for close monitoring (which is another cost of caring for a patient on Warfarin, manning a coumadin clinic, not counted in the pill price). Note – may be, they are not needed for everyone. and as the article below states if you are successfull managed on Warfarin there may be no need to change.

the following link is a comparison by a respected and unbiased physician on the pros and cons of these new blood thinners. The need to select patients and to explain how a new treatment works after so many years of only having one including the new risks of these drug may justify spending time with physicians for education of these new issues.

There is also a methodological bias in the way the spend is analyzed, the article reports that most of the spend is for drugs approved recently, but bemoans the fact that drugs which offer a cure aren’t on the list. Those types of agents are typically prescribed by a much narrower specialty so even a robust education and marketing program may not hit the top spender list for this type of analysis. There are also just a lot fewer drugs of the “cure” category that come through the pharma pipeline, its a much more difficult and failure ridden path then making improvements to existing treatments.